James Keck, MD, set out to find if adult patients at an academic family medicine clinic, who were actively screened for prediabetes, received a referral to the Diabetes Prevention Program.

The research team evaluated the electronic health records of 5,360 adult patients at an academic family medicine clinic to determine whether they received pre-diabetes screening, diagnosis and treatment.

They found that:

• 4,068 (76%) patients received a hemoglobin A1c test.
• 1,437 (35%) of these patients had a result in the prediabetes range.
  • Of these, only 729 (51%) had a diagnosis of prediabetes their EHR

Even though 35% of patients met the diagnostic cut off for prediabetes, not one of them was referred to a Diabetes Prevention Program.

Keck and colleagues also reviewed 31 surveys from clinicians from the same clinic about their pre-diabetes attitudes, knowledge and practices. Keck noted that even when clinicians are aware of the program, insurance coverage for such programs is low even though more and more insurers are recognizing the wisdom in these prevention programs.

James Keck, a physician at the University of Kentucky, believes this is due to a lack of awareness about the Diabetes Prevention Program in general.

The lack of electronic or streamlined referrals to these programs is another notable barrier, besides perceptions of the clinician and individual of whether the program will be effective.

What can be done about this?

Raising awareness about the National Diabetes Prevention Program is the first step, as well as raising awareness of private insurance and Medicare which now covers such programs. Finally, increasing relationships between clinics and places offering these programs (or encouraging clinics to start up their own programs) is a great step towards removing barriers.

Read more on the full survey results and recommendations on Healio.

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Whether it’s the candy, the turkey, stuffing, or the desserts, the holidays are a difficult time for anyone to eat healthy and avoid weight gain. Experts suggest that the holidays are not the best time to set weight loss goals. Instead, a more realistic approach is to focus on enjoying special events and weight maintenance coupled with lots of good self-care.

Weight watchers, most dietitians, and health bloggers suggest several strategies to make healthier choices when tempted by holiday fare:

• There is no need to eat to be polite – save calories or points for favorite foods. If there is lots of pressure, have 1-3 bites of whatever family or friends are suggesting.
• Be prepared for extra calories: maintain regular eating routine for the whole week leading up to the big meal. On the day of, make sure to have breakfast, and if the big meal is in the afternoon, have a small lunch or snack to avoid over-eating at the party.
• Drink calorie free beverages and choose vegetables or other low calorie options first before digging into the richer food choices.

Some interesting, alternative strategies that people are reporting success with:

• Plating up with a smaller plate: it tricks our brains into thinking we are eating more, and on average this strategy decreases intake by 40% or more.
• Wear something fitted and fabulous: boost self-confidence with an outfit that makes the wearer feel great about how they look, but also keeps them aware of quantity of food consumed.
• Take a walk after the meal instead of sinking into a recliner or couch to burn a few calories and keep metabolism revved up a bit longer.

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Continuous Glucose Monitoring – The key to improving BG?

A three-year long study showed real time continuous glucose monitoring (rtCGM) was associated with lower A1c levels in people with type 1 diabetes, whether the participants used pumps or multiple daily injections.

In the study, participants checked glucose levels using CGM or fingersticks four times per day.

Only the real time CGM group had improvements in time-in-range and reduced time below range, regardless of whether they used an insulin pump or injections.

Also, fewer participants using real time CGM experienced severe hypoglycemia.

This three-year study came from the Comparison of Different Treatment Modalities for Type 1 Diabetes Including Sensor-Augmented Insulin Regimens (COMISAIR). The group still advocates for individualization of treatment, but emphasizes what an important difference incorporating real time CGM makes.

Jan Soupal presented the study findings at the European Association for the Study of Diabetes 2019 Annual Meeting in the Czech Republic. Soupal noted that CGM can be coupled with multiple daily injections for those who prefer to only have one device on their body or worry about accessibility and affordability.

Read the full study details here.

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Want more valuable CGM info for the test?

Check out our Technology Toolkit! Two fantastic courses included for a total of 3 CEs:

• Tech 101 – Pumps and Sensors Update and Overview and 
• Tech 102 – Insulin Pump Calculations: From Basal to Square Bolus 

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Adverse Childhood Experiences (ACE) such as neglect, abuse, household dysfunction, etc. have been found to have a profound impact on health and disease throughout life.

Here is the the link to the ACE Screening Tools and more information.

The higher the ACE Score, the higher the risk of diabetes, cardiovascular disease, mental health issues, earlier mortality and more.

Nadine Burke Harris, MD and California’s newly appointed Surgeon General, pushed for ACE scores to be more seriously considered and to increase routine screening, early detection, and early intervention.

Funding has been put forward to reimburse providers for screenings, and towards after school education and safety programs in preschool, early learning, and childcare.

Dr. Harris corrects the assumption that every person who scores positive for ACE needs mental health services: “most patients don’t” she says, and it’s important to know proper next-steps after a positive screening.

The best thing health care providers can do after a positive screening is to educate individuals on which symptoms could be related to a history of adversity, and give them tools they can use to manage and improve outcomes. These are tools like sleep, exercise, nutrition, mindfulness, mental health, and healthy relationships. Most of these tools don’t require a lot of extra resources as some health care professionals may fear.

Read Dr. Harris’ full interview on the Chronicle of Social Change.

For more info, here is the link to an excellent ACE Resource Page

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Canagliflozin (Invokana), an SGLT-2 Inhibitor, just received a new Food and Drug Administration (FDA) indication.

Adults with type 2 diabetes and diabetes kidney disease who take canagliflozin (Invokana) experience a reduction of:

• end-stage renal disease
• worsening kidney function
• cardiovascular death
• hospitalization for heart failure
  

This new indication is based on the results of the CREDENCE Trial, which was designed to see if canagliflozin had a renal vascular protective effect.

The trial enrolled over 4, 400 people with type 2 diabetes and GFRs between 30 and 90. The results clearly indicated several benefits.

Researchers observed a 32% risk reduction of end stage renal disease among patients who took canagliflozin (HR = 0.68), as well as a 28% risk reduction for starting dialysis, having a kidney transplant or experiencing renal death.

In a sub-group of the CREDENCE Trial, cardiovascular death for type 2 diabetes dropped by over 30% and in the CANVAS Study, there was a 33% drop in risk of hospitalization for heart failure.

Please see Oral Meds Pocketcard for side effects and precautions of canagliflozin and SGLT-2 Medications. In the most recent ADA Standards, two SGLT-2 Inhibitors, empagliflozin and canagliflozin are indicated for individuals with heart failure, chronic kidney disease and an elevated CV risk profile.

The use of these SGLT-2 Inhibitors offer hope and a new strategy to protect renal function and decrease heart disease risk in those living with diabetes.

For more information see this Helio Article on the new FDA indication for Canagliflozin.

Please see our GLP-1 Receptor Agonists and Injectibles Pocketcard for new oral GLP-1 tablet.

Get Your Updated PocketCards Here!

Download FREE Medication PocketCards on our website.

Purchase PocketCards – Updated physical PocketCards will ship out no later than October 18, 2019.

Download our FREE CDCES Coach App

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The Journal of General Internal Medicine recently surveyed nearly 300 physicians, and the findings were alarming.

Their research suggests approximately 25% of all physicians misdiagnose people who have diabetes with prediabetes instead.

Additionally, the average provider didn’t know 33% of the risk factors for prediabetes, were unfamiliar with prevention or management of the condition, and generally under-screened for it.

Only 42% of the physicians knew the correct fasting A1c to diagnose prediabetes.

Researchers from John Hopkins University recommend providing physicians with better knowledge on diabetes prevention and for insurance to cover plans that help better diagnose and treat prediabetes.

The hope is these two strategies will help with more accurate screening and earlier intervention to avoid development and progression of type 2 which can lead to kidney failure, heart disease, or stroke. Read the full study and statistics here.

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October Newsletter Now Available!

Our October Newsletter is brimming with medication updates! From Oral GLP-1 to Semaglutide and pre-filled Glucagon, we’re keeping you up to date AND updating our PocketCards. Did you know you can hire Coach Beverly to come speak in your hometown? Read this month’s Newsletter to find out how to request her time. 

October News Topics Include:

• Oral GLP-1: Easier to Stomach than Injectables?
• Canagliflozin Slows Kidney Disease and Protects the Heart
• Diabetes & Breast Cancer
• 25% Off Live Webinars
• Updated DiaBingo
• 7 Strategies to Survive Halloween

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Happy Mindful Monday! Today we’re offering a new perspective by showcasing dishes around the world. This comes from the New York Times after they interviewed 18 families around the world to see what their typical weeknight dinner is:

In Bangkok, Thailand:

Omelet with carrots, stir-fried minced pork and eggplant, and Thai sour curry with cauliflower is a common meal. Family members are expected to clean up after themselves and help cook at least one night a week.

In Gurgaon, India:

The Osan family eats around 9 p.m., normally with palak paneer (spinach with cheese), raita, kadai aloo (potatoes with onions and spices), cucumber salad and roasted chapatis.

In Rome, Italy:

The mother normally cooks for the rest of her family, and an easy weeknight meal includes saltimbocca (veal rolled with ham and sage), homemade pesto with trofie pasta, and baked tomatoes au gratin.

In Riyadh, Saudi Arabia:

The Khojandi family eats a mix of prepared and homemade foods during the weeknight. This includes smashed beans, shakshuka (eggs poached in a tomato and green pepper stew with onions and garlic), and masoob (a mix of banana, bread, dates, cream, and honey.

In Port-au-Prince, Haiti:

Many Haitian families take their main meal at midday. The Charles’ family prepares avocado, white rice, sos pwa nwa (black bean puree), beef and blue crabs marinated in orange and lime, and lalo (boiled jute leaves and chopped spinach).

In Rehovot, Israel:

The Levy family eats Yemeni soup, chicken schnitzel, chraime (white fish in tangy and spicy tomato sauce with smoked paprika and cilantro), with challah (bread) and rice.

In Paris, France:

In Paris, roasted chicken and couscous were part of an early dinner for the Devouges. Their meal ended with various cheeses (Petit Suisse, Comte, and Emmental).

In KwaZulu-Natal, South Africa:

Chakalaka (relish made with fried peppers, grated carrots, and baked beans) is a South African favorite. Ujeqe (steamed bread) and braised oxtail is a common weeknight meal.

In Western Australia:

The Opie family eats pan-fried nannygai (red snapper), broccolini, and sweet potato fries for dinnr. Their children get extra fruits and vegetables like strawberries, raspberries, snow peas, and carrots.

In Amsterdam, Netherlands:

The Henkets eat a dinner of salmon with basmati rice and broccoli and a dessert of homemade custard with fresh raspberries and berry jam.

In Lagos, Nigeria:

In Lagos, their meal revolves around the sauces. With plantain flatbreads and chicken suya, condiments include peanut butter sauce, papaya chutney, hibiscus green chile sauce, mint and spring onion oil, tamarind ginger sauc, and beet and carrot sauerkraut.

In Monterrey, Mexico:

Huevos revueltos (scrambled eggs with chorizo and onions, served with flour tortillas) is a staple, even for dinner.

In Moscow, Russia:

Liza prepares dinner for her husband and six children. While she cooks, the children and her husband are in charge of setting the table. Kotleti (beef patties with bread, egg, and onion), rice, green salad, and an eggplant, red pepper, basil salad make for a perfect weeknight meal.

In Tokyo, Japan:

Fish, rice, and miso soup are a classic Japanese meal. Yasuko cooks for her adult son a few nights a week, with mebaru (rockfish) being on the menu that night. Fresh fruit serves as dessert.

In Istanbul, Turkey:

Kofte (meatballs), lentil soup, bulgur pilaf with tomato and bell pepper, dolmas (stuffed grape leaves) and red beans in olive oil make up the Terzi family dinner. A rice pudding called sutlac with tahini and walnuts is for dessert.

In Sao Paulo, Brazil:

In Brazil, the mom cooks the meal of picadinho (beef, potato and carrot stew) with rice and salad, while the dad sets the table. The children are expected to clean up afterward.

Read full descriptions and see in-home photography from the New York Times report!

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